VASCULAR ACCES S
Driving best practice in vascular access
Clinical educator, Linda Kelly, explores the national precedence being placed on infection prevention and control, and calls for the standardisation of care and maintenance of vascular access devices.
According to UK data, one in three patients will have at least one cannula inserted during their hospital stay,1
With estimates
highlighting usage among 4.3 patients in England during 2020-2021 alone. Despite the fundamentals of care and infection prevention being taught within the first year of medicinal and nursing study, ongoing dedication to care and maintenance of devices, once in situ, can sometimes be overlooked. This may be due to variation in practices, even between departments of the same Trust.
Risks of unstandardised care Vascular access devices cover everything from basic catheters and peripherally inserted central catheters (PICCs), to midlines and central venous catheters (CVCs). These devices are a vital part of intravascular therapy and can remain in-situ throughout a patient’s hospital stay and even during outpatient treatment. This means that the number of healthcare professionals that encounter even a single device, can be varied and risks deviation in maintenance procedures. As suggested by Napalkov et al: “Although vascular access devices (VAD) have many advantages, the burden of harm associated with them is significant. Complications can occur in all devices and are a significant burden on healthcare.”2
Such complications
include: occlusion (including mechanical, chemical, thrombotic, and persistent withdrawal), phlebitis, drug infiltration and extravasation, infectious complications, and dislodgement. Following device insertion, to
prevent post-insertion complications, it is important that the device is managed correctly. Most post-insertion complications are attributed to poor care and maintenance practices. According to Ullman et al3 “many such complications and failures are preventable.”
These incidences are not to be taken
lightly, with The European Centre for Disease Control (ECDC) estimating that 4.1 million patients per year develop infections within the European Union (EU) as a result of healthcare, and that 37,000 deaths result annually due to such infections. The economic burden of healthcare-associated infections (HCAIs) is significant. Annual losses associated with HCAIs are estimated at 7 billion euros and 16 million extra days in hospital for patients.4
(WHO, 2011) Although these stats are not exclusive to
Following device insertion, to prevent post-insertion complications, it is important that the device is managed correctly. Most post-insertion complications are attributed to poor care and maintenance practices.
JANUARY 2023
vascular access devices, we cannot ignore that they represent a significant number within these figures, and it is of benefit of both patient and healthcare providers to take measures to reduce such incidences.
Returning to the fundamentals of care with vascular access devices The practices of caring for a vascular access device are not revolutionary in their approach but are more about re-establishing the return to the fundamentals of care. At Vygon, we follow six core principles for caring for a vascular access device: 1. Choosing the right line for the patient from the outset.
2. Hand-washing best practice. 3. ANTT®
: Aseptic non-touch technique.5
4. Needle-free devices and active disinfection. 5. Dressing and regular monitoring of vascular access sites.
6. Adequate catheter clearance.
Choosing the right line, for the right patient, at the right time Upon patient admission, selecting the right line for the patient can help with their journey and ultimately how the device is cared for and maintained throughout placement. Considerations should be made
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